Provider Demographics
NPI:1003190810
Name:FLORIDA COUNSELING CENTERS FAMILY SERVICES
Entity Type:Organization
Organization Name:FLORIDA COUNSELING CENTERS FAMILY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:RONSISVALLE
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:321-259-1662
Mailing Address - Street 1:1299 BEDFORD DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32940-1900
Mailing Address - Country:US
Mailing Address - Phone:321-259-1662
Mailing Address - Fax:321-259-1223
Practice Address - Street 1:1299 BEDFORD DR
Practice Address - Street 2:SUITE A
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32940-1900
Practice Address - Country:US
Practice Address - Phone:321-259-1662
Practice Address - Fax:321-259-1223
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-29
Last Update Date:2011-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL885054550251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health